Healthcare Provider Details

I. General information

NPI: 1477561660
Provider Name (Legal Business Name): KEITH WILLIAM VRBICKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 NORTH 13TH STREET
NORFOLK NE
68701
US

IV. Provider business mailing address

1410 NORTH 13TH STREET
NORFOLK NE
68701
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-2322
  • Fax: 402-379-0888
Mailing address:
  • Phone: 402-379-2322
  • Fax: 402-379-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15770
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: